[Clinical utility of available diagnostic tests in prostatic carcinoma. Results of 500 biopsies. I. PSA, PSA density, and predicted PSA]. / Utilidad clínica de las pruebas diagnósticas disponibles en el carcinoma prostático. Resultados sobre 500 biopsias. Parte I: PSA, densidad de PSA y PSA predecible.

OBJECTIVE: To study the utility of PSA density and predicted PSA results in the diagnosis of prostatic cancer using gland volume. METHODS: 500 patients suspected as having prostatic cancer underwent ultrasound-guided transrectal biopsy. Prostate volume and ultrasound characteristics, serum PSA density, predicted PSA and the difference between both were determined. RESULTS: 44.8% of the patients showed evidence of cancer in the biopsy specimen. These patients had a significantly smaller prostate. The 0.1 and 0.15 PSA density cutoffs had a sensitivity of 96% and 94%, specificity of 10% and 20% and positive predictive value of 46% and 49%, respectively. The statistical values for PSA difference of 1 and 2 were 94% and 92%, 13% and 18%, 47% and 48%, respectively. CONCLUSION: PSA density and predicted PSA results could be useful to avoid biopsies in patients with PSA between 4 and 10 ng/ml and no malignant tumor of the prostate.

[Clinical utility of available diagnostic tests in prostatic carcinoma. Results of 500 biopsies. II. Rectal palpation, PSA, and transrectal echography]. / Utilidad clínica de las pruebas diagnósticas disponibles en el carcinoma prostático. Resultados sobre 500 biopsias. Parte II: Tacto rectal, PSA y ecografía transrectal.

OBJECTIVE: To analyze and compare the diagnostic yield of transrectal ultrasound versus digital rectal examination (DRE) and PSA. METHODS: 500 patients with a suspicion of carcinoma of the prostate were evaluated by US-guided transrectal biopsy, PSA determination and DRE. The sensitivity, specificity and predictive values of these diagnostic methods, utilized alone or in combination, were analyzed. RESULTS: 44.8% of the patients had evidence of cancer in the biopsy specimen. DRE disclosed an indurated prostate in 32% and 45% of the ultrasound scans were suspicious of malignancy (74.2% of those in whom a tumor was demonstrated and 20.4% of those with no tumor, p < 0.001). DRE, PSA > 4 ng/ml and transrectal ultrasound had a sensitivity rate of 52%, 93% and 74%, and a specificity of 85%, 10% and 79%, respectively. The highest sensitivity rate was obtained when biopsy was indicated by an indurated prostate on DRE or PSA > 4 ng/ml or a suspicious transrectal ultrasound scan (96%). The highest diagnostic accuracy, with a specificity of 96%, was obtained in patients with PSA > 10 ng/ml and positive DRE and transrectal ultrasound. CONCLUSION: The combined use of the different tests is fundamental to early diagnosis of prostatic cancer. In our experience, transrectal ultrasound was the method which independently obtained the best predictive values, offering a high sensitivity and specificity.

[Tuberculous prostatic abscess in acquired immunodeficiency syndrome]. / Absceso prostático tuberculoso en síndrome de inmunodeficiencia adquirida.

OBJECTIVE: To review the diagnostic and therapeutic aspects of prostatic abscess in the acquired immunodeficiency syndrome. METHODS/RESULTS: Herein we report on a patient with AIDS and prostatic abscess due to tuberculosis. The clinical features and a less invasive therapeutic approach are described. CONCLUSION: Appropriate treatment must be based on cultures, as patients with AIDS are increasingly frequently affected by uncommon organisms originating prostatic abscess. Treatment is by drainage, although spontaneous urethral drainage has been described, as in the present case. Percutaneous ultrasound-guided drainage appears to be a less invasive and effective procedure.

[Endocrine changes and sexual dysfunction in kidney transplantation and hemodialysis: comparative study]. / Alteraciones endocrinas y disfunción sexual en trasplante renal y hemodialisis: estudio comparativo.

OBJECTIVE: The objective of this paper is to compare the hormonal changes and sexual activity between transplanted patients and patients in regular haemodialysis (HD). MATERIAL AND METHODS: 130 patients, 98 RT carriers and 32 with CRF were evaluated with regard to the sexual function. The etiology of CRF is similar in both groups. All patients underwent hormonal determinations (FSH, LH, Prolactin, Testosterone, Oestradiol and PTH), complete serum testing and other diagnostic studies done selectively, 38 of 130 patients (14 in HD and 24 transplants) answered a personal questionnaire on sexual activity. RESULTS: Oestradiol and prolactin levels are higher in the HD group compared to transplanted patients (p < 0.05). 70% of RT patients maintain their libido versus 35% of those in dialysis (p < 0.01). The former group refers good erection in 55% cases versus 21% of dialysis patients (p < 0.01). Intercourse frequency and degree of overall satisfaction is higher in the RT group (N.S.). CONCLUSIONS: No significant differences were found in FSH, LH and testosterone levels. The normality of FSH levels may be a reflection of the integrity of the germinal line. 65% HD patients refer decreased or absent libido, to which the higher levels of prolactin and oestradiol found could contribute. No relationship was found between sexual function with the type of immunosuppression or the graft function.

[Chronic prostatic inflammation: a confounding factor in the diagnosis of prostatic cancer]. / Inflamación prostática crónica: un factor de confusión en el diagnóstico del cáncer prostático.

OBJECTIVES: To evaluate the influence of inflammatory foci of the prostate on the efficacy of PSA and transrectal ultrasound in the diagnosis of prostatic cancer. METHODS: Ultrasound-guided transrectal biopsy was performed in 399 patients. The results of serum PSA, PSA density and ultrasound characteristics were compared with the pathological findings. RESULTS: The mean prostatic volume was greater in the cases with BPH and chronic inflammatory foci than those with prostatic cancer (p < 0.001). Twenty percent of the patients showed suspicious areas vs 75.1% of the cancers (< 0.001); 66.7% of those with chronic inflammatory foci showed classifications vs 40.6% of the cancers (p < 0.001). The patients with chronic inflammatory foci had PSA values that fell in between those of the BPH and cancer groups (p < 0.05). PSA density also showed intermediate values, although they were not significantly different. CONCLUSIONS: The presence of chronic prostatic inflammatory foci can increase serum PSA levels. To date, it is not possible to identify this group of patients to avoid a biopsy.

[Usefulness of the urodynamic study of the lower urinary tract in renal transplantation]. / Utilidad del estudio urodinámico del tracto urinario inferior en el trasplante renal.

OBJECTIVES: To analyze the indications, diagnostic cost-effectiveness and therapeutic implications of urodynamic assessment of the lower urinary tract in two groups of patients: 1) those awaiting renal transplantation and those with a functioning renal graft and voiding disturbances. METHODS: The first group comprised 22 patients who were evaluated before renal transplantation for a total of 32 urodynamic studies. The second group comprised 10 patients with a functioning renal graft for a total of 14 post-transplant urodynamic studies. The etiology of the chronic renal failure, indications for urodynamic assessment and videourodynamic findings in both groups were compared. RESULTS: Interstitial nephropathy associated with vesicoureteral reflux was the most common cause of chronic renal failure in the pre-transplant group, whereas glomerular nephropathy was the most common cause of chronic renal failure in the posttransplant group. Vesicoureteral reflux was the most frequent videourodynamic finding and was associated with other urodynamic disturbances in 75% of the cases. Lower urinary tract obstruction was the most common finding in the posttransplant group. CONCLUSIONS: The indications for urodynamic study in patients awaiting renal transplantation are: 1) interstitial nephropathy associated with vesicoureteral reflux, neurogenic bladder and congenital malformations; 2) patients aged 45 or older with a flowmetry suggesting obstruction; 3) those with urinary diversion, and 4) systemic diseases potentially associated with neurological damage.

[Definitive endourological treatment in urothelial tumors of the upper urinary tract]. / Tratamiento endourológico con intención resolutiva en tumores uroteliales del tracto urinario superior.

OBJECTIVES: We reviewed our series of upper urinary tract tumors submitted to endoscopic management as definitive treatment. METHODS: The series comprised 18 patients with transitional cell carcinoma of the upper urinary tract; 14 were treated by the percutaneous approach and 4 by ureteroscopy. All of them were single, papillary and low grade tumors. In 17 patients we analyzed the nephrostomy track for local tumoral seeding. RESULTS: The mean follow up was 29 months. Fourteen patients remain free of recurrent disease (5-84 months); 2 patients recurred and 2 others were diagnostic errors. No evidence of tumoral seeding was observed. CONCLUSIONS: Percutaneous or ureteroscopic surgery can achieve cure in selected cases. Local recurrence outside the urinary tract ascribable to percutaneous surgery appears to be unlikely.

[Potential of ultrasonography in urologic diagnostic algorithms]. / Posibilidades de la ecografía en los algoritmos diagnósticos urológicos.

OBJECTIVES: The present study analyzed the place of ultrasound in the urological diagnostic protocols. Currently, most of the patients undergo some type of ultrasonographic evaluation at the outset or at some time during follow up. Our experience concerning the results, limitations and errors of this imaging technique are presented. METHODS: We reviewed the indications for US in different pathologies and its use together with other diagnostic techniques. Simple, cost-efficient algorithms are described. RESULTS: Its excellent performance permits making a correct diagnosis in many patients and remarkably simplifies evaluation in others. Its accuracy obviates the need for other explorations in certain pathologies. CONCLUSIONS: Ultrasound must be included in the urological armamentarium and should be considered as an extension of physical examination. Its accuracy and efficacy have been demonstrated. Furthermore, it is simple and easy to use, low-cost, and remarkably simplifies our diagnostic algorithms.